Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial.

Authors:	John P O'Reardon, H Brent Solvason, Philip G Janicak, Shirlene Sampson, Keith E Isenberg, Ziad Nahas, William M McDonald, David Avery, Paul B Fitzgerald, Colleen Loo, Mark A Demitrack, Mark S George, Harold A Sackeim
Language:	Eng.
Date:	2007-11-13
Journal:	Biological Psychiatry (0006-3223)
Release:	Biol Psychiatry. 2007 Dec;62(11):1208-16
Abstract:	BACKGROUND: We tested whether transcranial magnetic stimulation (TMS) over the left dorsolateral prefrontal cortex (DLPFC) is effective and safe in the acute treatment of major depression. METHODS: In a double-blind, multisite study, 301 medication-free patients with major depression who had not benefited from prior treatment were randomized to active (n = 155) or sham TMS (n = 146) conditions. Sessions were conducted five times per week with TMS at 10 pulses/sec, 120% of motor threshold, 3000 pulses/session, for 4-6 weeks. Primary outcome was the symptom score change as assessed at week 4 with the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcomes included changes on the 17- and 24-item Hamilton Depression Rating Scale (HAMD) and response and remission rates with the MADRS and HAMD. RESULTS: Active TMS was significantly superior to sham TMS on the MADRS at week 4 (with a post hoc correction for inequality in symptom severity between groups at baseline), as well as on the HAMD17 and HAMD24 scales at weeks 4 and 6. Response rates were significantly higher with active TMS on all three scales at weeks 4 and 6. Remission rates were approximately twofold higher with active TMS at week 6 and significant on the MADRS and HAMD24 scales (but not the HAMD17 scale). Active TMS was well tolerated with a low dropout rate for adverse events (4.5%) that were generally mild and limited to transient scalp discomfort or pain. CONCLUSIONS: Transcranial magnetic stimulation was effective in treating major depression with minimal side effects reported. It offers clinicians a novel alternative for the treatment of this disorder.
Copyright:	Biological Psychiatry Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19014, USA.
Full text:	DOI - Biological Psychiatry (DOI) EBSCO - HTML (needs subscription) Elsevier Science - HTML (needs subscription) Swets Information Services - HTML (needs subscription)
Terms:	Adolescent, Adult, Aged, Audiometry, Depressive Disorder, Major, Double-Blind Method, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Transcranial Magnetic Stimulation, Treatment Outcome